Metformin use and asthma outcomes among patients with concurrent asthma and diabetes

Abstract

Background and objective: Metformin is a first-line treatment for patients with diabetes. Recent animal studies indicated that metformin can reduce airway inflammation. However, it remains unclear whether the use of metformin can help patients maintain asthma control. The purpose of this study was to evaluate the association between the use of metformin and asthmarelated outcomes, which include asthma-related hospitalization, asthma-related emergency room visits and asthma exacerbation, among patients with concurrent asthma and diabetes. Methods: We conducted an 11-year (2001-2011) retrospective cohort study using the Taiwan National Health Insurance Research Database. Patients with concurrent asthma and diabetes were included. The date of the first observed prescription of metformin was defined as the index date. For each metformin user, two matched metformin non-users of the same age and gender were randomly selected. Patients were followed for 3 years to measure the occurrence of asthma-related outcomes. Multivariable logistic regression models were used to assess the association between metformin use and asthma-related outcomes. Results: Of 1332 patients with concurrent asthma and diabetes, 444 (33.3%) were metformin users. Compared with non-users, metformin users had a lower risk of asthma-related hospitalization (OR = 0.21, 95% CI: 0.07-0.63) and asthma exacerbation (OR = 0.39, 95% CI: 0.19-0.79). Conclusion: The risk of asthma-related outcomes was lower for metformin users than non-users. Health-care providers should consider metformin as a treatment strategy for patients with concurrent asthma and diabetes.

Glucagon-like peptide 1: A potential anti-inflammatory pathway in obesity-related asthma

“…Provocative studies have shown the potential of metformin, DPP-4 inhibitors, and statins in treating asthma (Huang et al, 2011; Li et al, 2016; Nader, 2015; Zeki et al, 2013). And while the GLP-1 pathway may also be effective, it is unclear which phenotypes of asthma it may help.…”

Obesity and severe asthma

“…Exactly how insulin resistance might promote asthma in the obese has not been established, but there is evidence of effects of insulin both on the immune system and on airway smooth muscle (71, 72). A retrospective analysis of data from 1332 patients with asthma and diabetes indicated lower risk of asthma hospitalization in patients who were taking metformin for treatment of their diabetes than in those who were not (73). However, a randomized controlled trial of treatment with another type 2 diabetes therapeutic, pioglitazone, indicated little benefit in obese asthmatics.…”

The effect of obesity, weight gain, and weight loss on asthma inception and control

“…A recent retrospective study in adults found that the use of metformin among patients with diabetes and asthma was associated with improved asthma outcomes 102 . Metformin, which acts via AMP-protein kinase (AMPK), has been shown to decrease eosinophilic airway inflammation and inhibit airway smooth muscle hypertrophy in murine models 103,104 .…”